Interventional cardiology on Minor Heart Attacks (non ST elevation type) no better than medical treatment outcomes at 10 years

It’s just a paper that shows that outcomes at 10 years are the same for less aggressive interventional (balloon catheter, auger drill, and stent) therapy.

Published in Cardiology
News · July 30, 2015
Early Invasive Strategy No Benefit 10 Years After NSTE-ACS
No improved outcomes versus selective invasive strategy in non-ST segment acute coronary syndrome

HealthDay
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For patients with non-ST-segment elevation acute coronary syndrome, routine early invasive strategy (coronary arteriography and myocardial revascularization, as clinically indicated) is not associated with improved outcomes at 10 years over a selective invasive strategy (coronary arteriography for recurrent ischemia only). The findings were published in the Aug. 4 issue of the Journal of the American College of Cardiology.
WEDNESDAY, July 29, 2015 (HealthDay News) — For patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), routine early invasive strategy (coronary arteriography and myocardial revascularization, as clinically indicated) is not associated with improved outcomes at 10 years over a selective invasive strategy (coronary arteriography for recurrent ischemia only). The findings were published in the Aug. 4 issue of the Journal of the American College of Cardiology.

Robert A. Henderson, D.M., from Nottingham University Hospitals in the United Kingdom, and colleagues reported 10-year outcomes from the Third Randomized Intervention Treatment of Angina (RITA-3) trial. They randomized 1,810 patients with NSTE-ACS to receive routine invasive or selective invasive strategies. Patients were followed annually up to five years, and mortality was documented over 10 years.

The researchers observed no differences in mortality between the routine invasive and selective invasive groups over 10 years (all cause death: 25.1 versus 25.4 percent; P = 0.94; cardiovascular death: 15.1 versus 16.1 percent; P = 0.65). Independent predictors of 10-year mortality included age, previous myocardial infarction, heart failure, smoking status, diabetes, heart rate, and ST-segment depression, in multivariate analysis.

“The advantage of reduced mortality of routine early invasive strategy seen at five years was attenuated during later follow-up, with no evidence of a difference in outcome at 10 years,” the authors write.

The RITA-3 trial was funded by a competitive grant from the British Heart Foundation, which received a donation from Aventis Pharma. One author disclosed financial support from The Medicines Company.

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6 responses to “Interventional cardiology on Minor Heart Attacks (non ST elevation type) no better than medical treatment outcomes at 10 years

  1. Sometimes the body should just be left alone to heal itself.

    That, and in areas with an abundance of medical care, the outcomes are very often worse than those in those with a relative paucity.

    Just a thought.

    VicB3

  2. Vic, your generally just a thought comments are usually pretty worthwhile.

  3. I did not understand the terminology.

    I have a stent. It is in what I think is called the LAD. I was told that without it I wouldn’t be here. Not then, not now and not in 10 years.

    Is this saying that they maybe they shouldn’t have put it in?

  4. Here’s the reason for this finding–non ST elevation MIs are not so severe.

    Aggressive interventions early in a non ST are not going to show the benefits that intervention does in bad boy lesions discovered at ST seg elevation MIs, which means all the way through the heart muscle.

    Mr. G a stent in the Left anterior descending coronary (LAD) is for a lesion in the major supply to the most important part of the heart muscle.

    The only worse lesion is in the left main–both lesions are potentially lethal if the complete obstruction occurs at the location of the lesion, that’s why they are ballooned, augured and stented. A stent is nothing more than an artificial circular splint to keep the vessel open for flow.

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